Jackie Fortiér, Author at ��ýҕ�l Health News

Listen: Cheap Health Insurance Isn’t Always Cheap

Jackie Fortiér — Tue, 21 Apr 2026 09:00:00 +0000

A lot of people choose their health insurance the way they shop for a flight — sort by the lowest price and click “buy.” But what looks like a bargain upfront can come with costly consequences later.

After some federal financial aid expired, many Americans found that high-deductible health plans were the only option they could afford.

In a new episode of NPR’s Life Kit podcast, ��ýҕ�l Health News reporter Jackie Fortiér and podcast host Marielle Segarra discuss what these plans are, and why they can feel so confusing. Imagine paying $100 out-of-pocket for a routine doctor visit that used to cost you $20. Imagine shouldering thousands of dollars in bills before your insurance pays a cent.

Still, for some people — especially those who rarely need medical care — high-deductible plans work. Listen to the episode to explore how timing your care and taking advantage of free preventive services can help you make the most of your coverage.

��ýҕ�l Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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How To Make a High-Deductible Health Plan Work for You

Jackie Fortiér — Mon, 13 Apr 2026 09:00:00 +0000

(Oona Zenda/��ýҕ�l Health News)

An elementary school teacher chose a low-price health insurance plan but soon realized she wasn’t clear about what it would mean for her family’s finances.

“Once I got the insurance card, I compared our old plan to our new plan, and that’s when I really got worried, because I didn’t really understand what a deductible was. It got me thinking, how do I use this insurance?”

— Madison Burgess, 31, of San Diego

When enhanced federal subsidies expired at the end of 2025, a lot of people buying their own health insurance on the state and federal exchanges saw their expected monthly rates jump. To keep costs down, many switched to a high-deductible health plan. These plans offer lower monthly payments, but in exchange patients can face steep out-of-pocket costs when they need care.

The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006.

Madison Burgess, a teacher in San Diego, gets health insurance through her teaching job. But when she investigated adding her husband to her plan, it was just too expensive, so she started shopping on the exchange for a cheaper option for him.

The longer she scrolled through the plan options, the more overwhelming it felt. Insurance jargon made it hard to tell what her family would owe if her husband got sick.

“I didn’t know what a deductible was, so I just went with what was cheap, and now I have regret,” she said.

In exchange for that lower monthly premium payment, her husband’s coverage won’t kick in for most care until they’ve paid $5,800 in medical bills. Burgess didn’t know that the deductible must be met before insurance picks up part of the tab.

Deductible:

The amount you as the patient have to pay before insurance picks up part of the tab

Premium:

The monthly bill for your policy, paid to the insurance company

How do you prepare for thousands of dollars in upfront costs? One option is a health savings account, or HSA, which lets you save pretax money and is now available to people enrolled in lower-tier state and federal exchange plans, including bronze and catastrophic coverage. These plans generally have the lowest premiums on the exchange but the highest out-of-pocket costs when you need care.

Burgess had chosen a bronze plan and didn’t know HSAs were an option.

“I’ve never thought about having to put money away for a deductible,” she said.

Burgess and others are often more worried about socking away money for unexpected car and house repairs or vet bills.

If, like Burgess, you chose cheaper health coverage for this year only to discover you’re on the hook for meeting a high deductible, these tips can help you prepare.

1. You might qualify for an HSA and not know it.

If you’re enrolled in a bronze or catastrophic plan, you qualify to open a health savings account. Think of it as a medical piggy bank with tax perks. You put in pretax money, which lowers your taxable income. The money grows tax-free, and when you spend it on , those transactions are also tax-free. That’s what people call a “triple tax advantage.”

These accounts build a cushion for future health costs, such as doctor visits, prescriptions, and even products like over-the-counter medicine, tampons, and sunscreen.

The money typically can’t be used for monthly premiums, but the account is yours to use for qualified medical expenses for yourself, your spouse, or your dependents anytime in the future. The money in the account is yours, even if you change jobs or health plans.

An HSA is not the same as a flexible spending account, or FSA. FSAs are tax-advantaged too but are offered only through employers. The money expires annually and you lose any remaining money when you leave that job.

2. HSA-curious? Here’s how to open one.

You open a health savings account through a bank or other financial institution. The institution will issue you a debit card so you can make purchases from the HSA.

You can at any point during the year as long as you’re covered by an eligible plan. You can choose where to open the account, but be sure to check for any fees financial institutions charge and shop around.

If you get insurance through your job, your employer may require you to use a specific IRS-approved company.

Many people decide they can’t afford to contribute to an HSA. For some households, the desire to set aside money for medical expenses competes with the need to pay rent and buy groceries.

But there’s a detail that can make it feel more manageable. Contributions don’t have to be large. Just a few dollars a month can get you started.

There is, however, a limit. The IRS sets an annual cap on how much you’re allowed to contribute to an HSA. In 2026, an individual is limited to $4,400, or $8,750 for a family plan. Under that ceiling, the amount is up to you.

3. Preventive services should be covered at no cost to you.

All plans sold on marketplaces must cover at no cost to the patient as long as the care is provided in-network. Those services include routine immunizations and cancer screenings.

Beyond preventive care, understanding what different services cost can help you decide which type of medical appointment works best for your health needs and your wallet. For example, some plans charge less for a telehealth visit than to see your primary care doctor in person.

Check out your for more details.

4. Seek care early in the year.

Most deductibles reset on Jan. 1. Scheduling appointments or surgeries early in the year can be strategic if you discover a condition that requires ongoing care. If you can afford it, meeting your deductible sooner can make the rest of the year significantly cheaper, said Caitlin Donovan, a senior director at the Patient Advocate Foundation.

5. Consider paying cash instead of spending down your deductible.

Some hospitals, clinics, or other providers offer cheaper prices if you pay cash. You have the and explanation of how much a health service would cost if you paid out-of-pocket. Ask for the estimate before you get care. Then, compare that price with what your insurance company tells you it would cost if you used your insurance. If you decide to go with a cash payment, you’ll need to pay while you’re still at the doctor’s office, before charges get submitted to your insurance company.

Paying cash may save you money, but the amount you pay generally won’t count toward your deductible or out-of-pocket maximum.

“If you don’t think you’re ever going to hit your deductible — you’re that young invincible, and your deductible is $10,000 — negotiate the cash price,” Donovan said.

6. On an ACA plan? Update your income and use an HSA to avoid a tax surprise.

If you’re on an ACA plan and you’re eligible for subsidies, be aware: If your and you don’t update your marketplace application, you could owe thousands of dollars at tax time. The . Report raises, new jobs, or side gigs as they happen. If your income goes up, stashing money in an HSA can help because the money you put in the account doesn’t count toward your taxable income.

As soon as you report an increase in your income, that could mean higher premiums (if you no longer qualify for the same subsidy), but experts say it’s better to pay now than owe a big bill that you have to pay all at once.

“One of the biggest problems I see is someone is newly unemployed and they sign up for coverage, they say that they’re not making any money, and then eventually they get a job and don’t report it, and then they have this huge tax bill at the end,” Donovan said.

She advises updating your marketplace profile as soon as your income changes, which could newly qualify you for Medicaid or a plan that contributes more toward your medical bills.

Taylor Cook contributed to this report.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and ��ýҕ�l Health News.

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Vaccines Jettisoned by CDC Safeguarded Millions From Disease

Arthur Allen — Fri, 09 Jan 2026 19:30:00 +0000

The federal government scaled back its recommended childhood vaccines, sidelining six that have safeguarded millions from serious diseases, long-term disability, and death.

Just three of those that the Centers for Disease Control and Prevention says it will no longer routinely recommend — against hepatitis A, hepatitis B, and rotavirus — have prevented nearly 2 million hospitalizations and 90,000 deaths in the past 30 years, according to .

Federal and private insurance .

Experts on childhood disease were baffled by the change, which the Department of Health and Human Services said followed “a scientific review of the underlying science.”

The vaccines are “held to a safety standard higher than any other medical intervention that we have,” said , a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”

Public health officials say the guidance puts the onus on parents to research each vaccine and its importance. Here’s what they prevent:

RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the U.S. It spreads in fall and winter, producing cold-like symptoms and causing tens of thousands of hospitalizations and hundreds of deaths yearly.

Hepatitis A. Hepatitis A vaccination, recommended for all toddlers since 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, still plagues adults, particularly people who are homeless or abuse drugs or alcohol, with reported in 2023.

Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children also plummeted with universal childhood vaccination.

Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, 70,000 young children were hospitalized and 50 died yearly from the virus, known as “winter vomiting syndrome,” said Sean O’Leary, a University of Colorado pediatrician. “It was a miserable disease that we hardly see anymore.”

Meningococcal disease. About 600 to 1,000 U.S. cases of meningococcal disease are reported yearly, killing more than 10% of those it sickens and leaving 1 in 5 survivors with a disability.

Flu. The virus has killed hundreds of children in recent years, though it tends to be much more severe in older adults.

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The CDC Just Sidelined These Childhood Vaccines. Here’s What They Prevent.

Arthur Allen — Tue, 06 Jan 2026 23:00:00 +0000

The federal government has drastically scaled back the number of recommended childhood immunizations, sidelining six routine vaccines that have safeguarded millions from serious diseases, long-term disability, and death.

Just three of the six immunizations the Centers for Disease Control and Prevention says it will no longer routinely recommend — against hepatitis A, hepatitis B, and rotavirus — have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years, according to .

Vaccines against the three diseases, as well as those against respiratory syncytial virus, meningococcal disease, flu, and covid, are now recommended only for children at high risk of serious illness or after “shared clinical decision-making,” or consultation between doctors and parents.

The CDC maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus, and diphtheria; the bacterial disease known as Hib; pneumonia; polio; chickenpox; and human papillomavirus, or HPV.

Federal and private insurance will still cover vaccines for the diseases the CDC no longer recommends universally, according to a Department of Health and Human Services ; parents who want to vaccinate their children against those diseases will not have to pay out-of-pocket.

Experts on childhood disease were baffled by the change in guidance. HHS said the changes followed “a scientific review of the underlying science” and were in line with vaccination programs in other developed nations.

HHS Secretary Robert F. Kennedy Jr., an anti-vaccine activist, pointed to Denmark as a model. But the schedules of most European countries are closer to the U.S. standard upended by the new guidance.

For example, Denmark, which does not vaccinate against rotavirus, registers around 1,200 infant and toddler rotavirus hospitalizations a year. That rate, in a country of 6 million, is about the same as it was in the United States before vaccination.

“They’re OK with having 1,200 or 1,300 hospitalized kids, which is the tip of the iceberg in terms of childhood suffering,” said Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of a licensed rotavirus vaccine. “We weren’t. They should be trying to emulate us, not the other way around.”

Public health officials say the new guidance puts the onus on parents to research and understand each childhood vaccine and why it is important.

Here’s a rundown of the diseases the sidelined vaccines prevent:

RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the U.S.

The respiratory virus usually spreads in fall and winter and produces cold-like symptoms, though it can be deadly for young children, causing tens of thousands of hospitalizations and hundreds of deaths a year. According to the National Foundation for Infectious Diseases, roughly 80% of children younger than 2 who are hospitalized with RSV have no identifiable risk factors. Long-awaited vaccines against the disease were introduced in 2023.

Hepatitis A. Hepatitis A vaccination, which was phased in beginning in the late 1990s and recommended for all toddlers starting in 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, continues to plague adults, particularly people who are homeless or who abuse drugs or alcohol, with of 1,648 cases and 85 deaths reported in 2023.

Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is particularly dangerous when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children has also plummeted as a result of universal childhood vaccination. But the hepatitis B virus is still around, with 2,000-3,000 acute cases reported annually among unvaccinated adults. More than 17,000 chronic hepatitis B diagnoses were reported in 2023. The CDC estimates about half of people infected don’t know they have it.

Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized and 50 died every year from the virus. It was known as “winter vomiting syndrome,” said Sean O’Leary, a pediatrician at the University of Colorado. “It was a miserable disease that we hardly see anymore.”

The virus is still common on surfaces that babies touch, however, and “if you lower immunization rates it will once again hospitalize children,” Offit said.

Meningococcal disease. Vaccines have been required mainly for teenagers and college students, who are notably vulnerable to critical illness caused by the bacteria. About 600 to 1,000 cases of meningococcal disease are reported in the U.S. each year, but it kills more than 10% of those it sickens, and 1 in 5 survivors have permanent disabilities.

Flu and covid. The two respiratory viruses have each killed hundreds of children in recent years — though both tend to be much more severe in older adults. Flu is currently on the upswing in the United States, and last flu season the virus killed 289 children.

What is shared clinical decision-making?

Under the changes, decisions about vaccinating children against influenza, covid, rotavirus, meningococcal disease, and hepatitis A and B will now rely on what officials call “shared clinical decision-making,” meaning families will have to consult with a health care provider to determine whether a vaccine is appropriate.

“It means a provider should have a conversation with the patient to lay out the risks and the benefits and make a decision for that individual person,” said , a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia.

In the past, the CDC used that term only in reference to narrow circumstances, like whether a person in a monogamous relationship needed the HPV vaccine, which prevents a sexually transmitted infection and certain cancers.

The CDC’s new approach doesn’t line up with the science because of the proven protective benefit the vaccines have for the vast majority of the population, Handy said.

In their report justifying the changes, HHS officials Tracy Beth Høeg and Martin Kulldorff said the U.S. vaccination system requires more safety research and more parental choice. Eroding trust in public health caused in part by an overly large vaccine schedule had led more parents to shun vaccination against major threats like measles, they said.

The vaccines on the schedule that the CDC has altered were backed up by extensive safety research when they were evaluated and approved by the FDA.

“They’re held to a safety standard higher than any other medical intervention that we have,” Handy said. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”

, a pediatrician in Orange County, California, said the change in guidance will cause more confusion among parents who think it means a vaccine’s safety is in question.

“It is critical for public health that recommendations for vaccines are very clear and concise,” Ball said. “Anything to muddy the water is just going to lead to more children getting sick.”

Ball said that instead of focusing on a child’s individual health needs, he often has to spend limited clinic time reassuring parents that vaccines are safe. A “shared clinical decision-making” status for a vaccine has no relationship to safety concerns, but parents may think it does.

HHS’ changes do not affect state vaccination laws and therefore should allow prudent medical practitioners to carry on as before, said , an attorney and a George Washington University lecturer who is leading litigation against Kennedy over vaccine changes.

“You could expect that any pediatrician is going to follow sound evidence and recommend that their patients be vaccinated,” he said. The law protects providers who follow professional care guidelines, he said, and “RSV, meningococcal, and hepatitis remain serious health threats for children in this country.”

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RFK Jr. Wants To Delay the Hepatitis B Vaccine. Here’s What Parents Need To Know.

Jackie Fortiér — Tue, 02 Dec 2025 10:00:00 +0000

[Update: On Dec. 5, 2025, a federal vaccine panel voted 8-3 to end the decades-long recommendation that all newborns receive a hepatitis B vaccine. The committee kept the recommendation that babies of mothers who test positive for the virus or whose status is unknown should be immunized soon after birth.]

Working out of a in Anchorage, Alaska, liver specialist Brian McMahon has spent decades treating the long shadow of hepatitis B. Before a vaccine became available in the 1980s, he saw the virus claim young lives in western Alaskan communities with stunning speed.

One of his patients was 17 years old when he first examined her for stomach pain. McMahon discovered she had developed liver cancer caused by hepatitis B, just weeks before she was set to graduate from high school as valedictorian. She died before the ceremony.

McMahon thinks often of an 8-year-old boy who showed no signs of illness until he complained of pain from what turned out to be a rapidly growing tumor on his liver.

McMahon can still hear his voice.

“He was moaning in pain, saying, ‘I know I am going to die soon,’” he recalled. “We were all crying.” The boy died at home a week later.

The hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic amounts, and the virus can survive on surfaces for a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

That outcome is now preventable. A birth dose of the vaccine, recommended for newborns since 1991, is up to in preventing infection from the mother if given in the first 24 hours of life. If babies receive all three doses, have immunity from the incurable virus, with the protection lasting at least .

In the communities of western Alaska, years of targeted testing and widespread vaccination efforts led to .

“Liver cancer has disappeared in children,” McMahon said. “We haven’t seen a case since 1995. Nor do we have any children under 30 that have gotten infected that we know of.”

He worries those hard-won gains could soon be rolled back.

Pushing Back the Dose?

A Centers for Disease Control and Prevention vaccine advisory panel appointed by Health and Human Services Secretary Robert F. Kennedy Jr. is scheduled the hepatitis B birth dose recommendation during its two-day meeting starting Dec. 4, potentially limiting children’s access.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that the hepatitis B birth dose is a “likely culprit” of autism.

He also said the hepatitis B virus is not “casually contagious.” But shows the virus can be transmitted through indirect contact, when traces of infected fluids like blood enter the body when people share personal items like razors or toothbrushes.

The committee’s recommendations carry weight. Most private insurers must cover the vaccines the Advisory Committee on Immunization Practices endorses, and many state vaccination policies are directly linked to its guidelines.

Neither ACIP nor the CDC is regulatory. They cannot mandate immunizations. It’s to do that. But keeping the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to vaccinate at birth, wait until later in childhood, or not vaccinate at all, and insurance will continue to cover the cost of the shot as long as it remains approved by the Food and Drug Administration.

Two senior FDA officials — Commissioner Marty Makary and top vaccine regulator Vinay Prasad — suggested at the end of November that the vaccine approval process may be coming. Vaccines must be approved by the FDA to be administered in the United States.

In obtained by and , Prasad questioned the routine practice of “giving multiple vaccines at the same time.” It’s not clear whether he was referring to combination vaccines that offer immunity against multiple diseases with a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The of the hepatitis B vaccine is given only as a stand-alone vaccine.

Contacted for comment, Health and Human Services spokesperson Emily Hilliard said in a statement that “ACIP will review the evidence at its meeting this week and issue recommendations based on gold standard, evidence-based science and common sense.”

‘Sowing Distrust’

If private insurers opt to still cover the shot, misinformation from the meeting still could lead families to falsely believe the vaccine could harm their babies, said , chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever comes out of this disaster of a meeting in December is going to be mainly designed around sowing distrust and spreading fear,” he said.

President Donald Trump, Kennedy, and some newly appointed ACIP members have mischaracterized how the liver disease spreads, ignoring or downplaying the risk of transmission through indirect contact. The hepatitis B virus is than HIV. Unvaccinated people, including children, can get infected from microscopic amounts of blood on a tabletop or toy, even when the infected person is asymptomatic.

McMahon has cared for children who tested negative at birth and later became infected through indirect contact. In a , nearly a third of such children went on to develop chronic hepatitis B without ever showing symptoms, he said.

“It’s a very infectious virus,” McMahon said. “That’s why giving everybody the birth dose is the best way to prevent it.”

The CDC recommends that all pregnant people be screened for hepatitis B, but it estimates that up to 16% are not tested and fall through the cracks. O’Leary and other experts say testing mothers for the virus shortly before or after delivery is unfeasible, because most hospitals lack the staff and resources.

The three-dose vaccine has a of safety. Numerous studies show it is not associated with an increased risk of , , , or , and severe reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get in a car wreck, right? And yet we all put our seat belts on. This is similar.”

The CDC estimates that 2.4 million people in the U.S. have hepatitis B and that half they are infected. The disease can range from an acute infection to a chronic one, often with . If the disease is left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure.

Expert’s Advice to Parents: Talk to a Doctor

, a professor of preventative medicine at the Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents struggle to understand why a healthy newborn needs a vaccine so soon after birth, especially for a virus they feel certain they don’t have and often wrongly associate only with risky behaviors. Those perceptions, he said, mix with declining trust in public health and rising skepticism about vaccines.

His advice to expectant parents who are on the fence is to talk to their doctor about the shots. Even if the pregnant woman has tested negative, he said, it’s still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily from surface contact. Babies who receive the full vaccine series starting from birth have their chance of .

“If you wait a month and if the mom happens to be positive, or the baby picks it up from a caregiver, by that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent that infection.”

He said that if fewer people get vaccinated, hepatitis B will circulate at higher rates in American communities and the risk of contracting the virus will rise for everyone who doesn’t get the shots.

And more hepatitis B cases could mean higher costs for patients and the broader health care system. The CDC estimates treating someone with a less severe form of the disease costs $25,000 to $94,000 per year. For patients who require a liver transplant, annual medical expenses can climb above $320,000, depending on their treatment.

Over the past 30 years, the parents have reported from their babies receiving the birth dose have been fussiness and crying, both of which pass quickly. Schaffner said that’s a very strong safety profile — for a newborn vaccine with a track record of protecting babies from an incurable disease.

“The data are so clear about this,” Schaffner said. “A whole array now of other countries have initiated this program. They’ve modeled it on us.”

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In Hepatitis B Vaccine Debate, CDC Panel Sidesteps Key Exposure Risk

Jackie Fortiér — Mon, 29 Sep 2025 09:00:00 +0000

The Trump administration is continuing its push to revise federal guidelines to delay the hepatitis B vaccine newborn dose for most children. This comes despite a failed attempt to do so at the most recent meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Both President Donald Trump and some newly appointed ACIP members have mischaracterized how the liver disease spreads, according to medical experts, including those working at the CDC. The ACIP panel’s recommendations can determine insurance coverage for immunizations.

At a White House press conference on Sept. 22, Trump, in advocating for delaying the newborn vaccine dose, falsely claimed that hepatitis B is solely a sexually transmitted infection.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,” Trump said.

Hepatitis B is a highly infectious virus that attacks the liver and is transmitted through contact with infected bodily fluids, including blood. It can also be passed from mother to baby.

A reporter asked if Trump had spoken with Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the CDC, about making the change, and Trump said he had, as Kennedy looked on.

Although hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, , including career CDC scientists, note that the virus can be transmitted in ordinary situations too, including among young children.

At the latest ACIP meeting, held Sept. 18 and 19, members debated postponing the hepatitis B newborn dose until 1 month of age.

CDC scientist outlined research showing incidences of unvaccinated children born in the U.S. to mothers who tested negative, later becoming infected with hepatitis B. Langer serves as acting principal deputy director for the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention.

Langer told the vaccine advisory panel that the virus can survive for outside the body on surfaces. During that time, contact with even microscopic traces of infected blood on a is enough for a child to be infected. This means unvaccinated children not considered at high risk can still be exposed in everyday environments, or by an infected caregiver.

“We do have data that says that it can happen and that it is likely to happen,” he said. Though the exact cause of infection may not be clear in documented cases of children of hepatitis B-negative mothers becoming infected, “I can tell you that it didn’t come from the mother and it didn’t come from injection drug use and it didn’t come from sexual contact, so that means that it had to have been some kind of casual contact,” Langer said.

Yet during the debate, some members gave little credence to the risk of transmission to children through household contact.

“This is a very, very important vaccine that should be given to the high-risk populations,” said ACIP voting member , a professor of operations management at the MIT Sloan School of Management. “The high-risk populations seem to be babies born to hep B-positive mothers, drug addicts, and other populations at high risk,” he said, despite Langer’s presentation highlighting other avenues of possible transmission.

Contrary to research that was presented, Levi later said the risk of not vaccinating children of hepatitis B-negative mothers was “probably close to zero” in the first few years of life.

The CDC estimates 2.4 million people in the U.S. have hepatitis B and half they are infected. The disease can range from an acute, mild infection to a chronic infection, often with . The disease has no cure and, if left untreated, can lead to serious conditions like cirrhosis, liver failure, and liver cancer later in life.

During debate on the vote to delay the newborn dose, ACIP member said that the proposed one-month gap would leave some children vulnerable to the virus, even if their mothers test negative for hepatitis B.

“This assumes implicitly that all the infections are coming from moms,” Hibbeln said. “You can’t decide on that simply by the mother’s status. You would have to look at the entire household’s status.”

ACIP member Evelyn Griffin, an obstetrician and gynecologist, asserted that doctors could ascertain an entire household’s hepatitis B status by asking the mother.

“How are they going to know?” Hibbeln said. “If 50% of people don’t know that they are hepatitis B-positive, you can ask all you want, and nobody knows.”

The committee members, all handpicked by Kennedy, ultimately decided to table the vote on whether to delay the newborn dose after Hibbeln brought up inconsistencies in the wording of the text of the resolution.

“The notion that hepatitis B is only confined to transmission for prostitutes, drug users, etc. is such an ignorant and uninformed way of approaching infectious disease,” internist , the president of the American College of Physicians and its liaison to ACIP, said when reached after the meeting.

“The virus does not care what your behavior or lifestyle is. The virus goes from person to person through bodily fluids,” Goldman said. It can be transmitted when an unvaccinated person touches infected bodily fluids on common surfaces and then accidentally touches the eyes or mouth. “What if someone was in a car accident and got exposed to blood?”

“It is not only mother-to-fetus transmission, it is not only certain risk groups,” he said. “This is why it’s universal; everyone should get this for their protection, and it is unfortunate that it is being politicized into a sexually transmitted disease and that’s it. That’s not an appropriate way to evaluate science.”

Pediatric vaccination recommendations are widely credited with nearly eliminating the virus in American-born children.

Babies infected at birth have a 90% chance of developing chronic hepatitis B, and a quarter of those children go on to have severe complications, like liver cancer, or to die from the disease.

In 1991, federal health officials determined newborns should receive their first dose of a hepatitis B vaccine within , which can block the virus from taking hold if transmitted during delivery. From 1990 to 2022, case rates of hepatitis B declined by more than 99%. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.

The next meeting of the ACIP is scheduled to begin Oct. 22. Agendas are usually posted weeks in advance, but so far, no information on the substance of the upcoming meeting has appeared on the CDC’s website. The agenda for the September meeting was posted less than a week before the meeting’s start.

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Listen: The Surprising Power of Pushback When Health Insurance Won’t Pay

Jackie Fortiér — Fri, 19 Sep 2025 09:00:00 +0000

Being denied insurance coverage can be both confusing and, at times, enraging. But mounting a skillful challenge can turn a “no” into “yes.”

From confusing policy language to coding errors to shifting insurer rules, a new episode of NPR’s “Life Kit” podcast explores why denials happen and how to avoid common pitfalls.

��ýҕ�l Health News reporter Jackie Fortiér and “Life Kit” host Marielle Segarra discuss the intricate and sometimes infuriating process of dealing with denied health claims. It’s an issue lots of people run into — but don’t necessarily talk about.

Fortiér and Segarra offer tips backed by real-life examples and expert advice, so you’ll know whom to call, what to say, and how being a pest in the right way might save you money.

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RFK Jr.’s Vaccine Panel Expected To Recommend Delaying Hepatitis B Shot for Children

Jackie Fortiér — Tue, 16 Sep 2025 09:00:00 +0000

A key federal vaccine advisory panel whose members were recently replaced by Health and Human Services Secretary Robert F. Kennedy Jr. is expected to vote to recommend delaying until age 4 the hepatitis B vaccine that’s currently given to newborns, according to two former senior Centers for Disease Control and Prevention officials.

“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, of the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the secretary’s.”

The vote was expected to take place during the next meeting of the CDC’s Advisory Committee on Immunization Practices, scheduled for Sept. 18-19.

For more than 30 years, the first of three shots of hepatitis B vaccine has been recommended for infants shortly after birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Pediatricians warn that waiting four years for the vaccine opens the door to more children contracting the virus.

“Age 4 makes zero sense,” pediatrician Eric Ball said. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine and covid-19 vaccines. Pediatricians worry changes to the schedules of these vaccines will limit access for many families, leaving them vulnerable to vaccine-preventable diseases.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former senior official spoke to NPR and ��ýҕ�l Health News on the condition of anonymity.

In response to questions from ��ýҕ�l Health News, HHS spokesperson Andrew Nixon wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public less than a week before it is scheduled to begin.

At the last ACIP meeting, in June, Martin Kulldorff, the chair and one of seven new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread. Kulldorff is a former Harvard Medical School professor who became known for during the pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” he said.

The virus spreads via direct exposure to an infected bodily fluid like blood or semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers have hepatitis B or are considered at high risk of the disease, the former officials said.

Protection From Birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within , which blocks the virus from taking hold if transmitted during delivery. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.

The prospect of ACIP’s altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, who has lived with the liver disease, likely since birth. Years of navigating the psychological, monetary, medical, and social aspects of chronic hepatitis B has touched almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said. Lo learned she had the disease due to a routine screening to study abroad in college.

Lo credits the vaccines with protecting her close family members from infection.

“I shared with my partner, ‘If you get vaccinated, we can be together,’” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B they are infected. It can range from an acute, mild infection to a chronic infection, often with . Most people with chronic hepatitis B were born outside of the U.S., and Asians and Pacific Islanders Black people have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, , according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s lifesaving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty Years of Universal Vaccination

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus’s replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

A dose of the hepatitis B vaccine. (Liz Hafalia/The San Francisco Chronicle via Getty Images)

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on people thought to be at highest risk of infection.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the health care practitioners who got hepatitis B infection. But we’ve learned so much more,” said , a professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime — newborns. The virus is from an infected mother to baby in late pregnancy or during birth.

“We may soon hear, ‘Let’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Schaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative while others acquired hepatitis B after they had been tested earlier in their pregnancies.

In 1991, Schaffner was a liaison representative to ACIP when it voted to for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 people 19 years old or under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. shows that in 2022 the rate among those 19 or under was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, note that it is possible for the virus to be transmitted in ordinary situations too, including among young children.

The virus can survive for outside the body. During that time, even microscopic traces of infected blood on a can pose a risk. If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children not considered at high risk can still be exposed in everyday environments.

Future Access Uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shots. That could leave parents to pay out-of-pocket for a vaccine that has long been provided at no charge. Children who get immunizations through the federal program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still an alternate liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

Schaffner is worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said, “and the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message ��ýҕ�l Health News on Signal at (415) 519-8778 or .

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Listen: As Kids Head Back to School, Parents Sort Out Confusion Over Vaccine Access

Jackie Fortiér — Tue, 02 Sep 2025 09:00:00 +0000

LISTEN: Many vaccines can run more than $100 a dose out-of-pocket. Jackie Fortiér tells WAMU’s “Health Hub” how Trump administration changes to the federal vaccine guidelines could make some routine shots too expensive for families.

Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, replaced the members of a federal vaccine advisory committee in June. The committee plays an important role in recommending vaccines, and its guidance influences the coverage decisions insurance companies make.

��ýҕ�l Health News reporter Jackie Fortiér appeared on WAMU’s “Health Hub” on Aug. 27 to explain why confusion over federal immunization policy has left parents and pediatricians uncertain about future access to childhood immunizations, especially for those on Medicaid.

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Try This When Your Doctor Says ‘Yes’ to a Preventive Test but Insurance Says ‘No’

Jackie Fortiér — Thu, 21 Aug 2025 09:00:00 +0000

(Oona Zenda/��ýҕ�l Health News)

Health Care Helpline helps you navigate the hurdles between you and good health care. ��ýҕ�l Health News reporter Jackie Fortiér spoke with NPR’s Ari Shapiro about a Minnesota family facing big bills for their infant son’s hearing tests.

“My son was diagnosed with congenital CMV, a virus that can cause hearing loss. As part of this diagnosis, he will be required to have routine hearing tests every few months until he is 10 years old. I reached out to you because I wanted to know why my son’s hearing tests weren’t covered by our insurance and why we needed to pay for it.”

— Anna Deutscher, 29, from Minnesota, writing about her infant son, Beckham

Trying to figure out why her claim was denied took Anna Deutscher a lot of time and work.

Baby Beckham’s hearing screenings were preventive care, which is supposed to be covered by law. Every hearing test cost them about $350 out-of-pocket. Between those bills and Beckham’s other health costs, the family maxed out two credit cards.

“Everything just immediately goes right to trying to pay that debt off,” Deutscher said.

At times, she felt overwhelmed by her son’s medical needs, on top of working. Deutscher said she “didn’t know what else to do” when her insurance company kept saying no to her requests that it pay for the hearing tests.

No one wants to spend time fighting their health insurance company. Many people feel they don’t have the knowledge or stamina to do it. But if, like Deutscher, you’re denied for a preventive service, it may be worth it.

Here are a few tips — a slingshot and a few stones, so you can be David when facing a health care Goliath.

1. Check your policy.

Read your plan documents to confirm whether the treatment or service is covered. Pay attention to any exclusions or limitations. Deutscher’s plan documents say hearing tests are not covered. But even when a sought-after benefit is excluded, that might not be the end of the line.

2. Is the service preventive?

Many types of preventive care are supposed to be covered without additional cost under the Affordable Care Act. If you receive a recommended preventive screening and have private insurance, including through the Affordable Care Act marketplace, there should be no copayment at the time of service, and you shouldn’t get a bill later. A small number of insurance plans are “grandfathered in,” which means you may not have the same rights and protections as the ACA provides. Check with your employer’s human resources benefits manager to find out for sure.

Here’s a health plans must cover and specific to children and young adults.

A physician recommended regular hearing screenings for the Deutschers’ baby, which the healthcare.gov list indicates should be considered preventive and covered by insurance. But , an insurance expert and a research professor at Georgetown University, said real life often doesn’t match what the law requires.

“It really does come down to everyone sort of being on their best behavior on the provider and plan side to truly interpret and follow what should be covered,” Volk said.

3. Peel apart the denial.

If you’ve been denied coverage, you need to know why. Health insurance companies are required to explain every denial. The denial letter or your explanation of benefits should state the reason, which may be a coverage exclusion, incorrect coding, or a determination that the service was deemed not medically necessary. Follow up and ask for specific details about the denial and the criteria used, and request an explanation of benefits. Then use that information to , being sure to address the reason for the denial.

4. File the appeal.

There are a few steps to know, but you don’t have to be a lawyer to figure them out. Usually there’s an appeal form to fill out. Visit your insurer’s website, check your explanation of benefits, or call your insurer and ask how to get started. The process typically includes writing a letter saying why you disagree with the denial. Include any medical records or test results that support your case and a copy of the federal guidelines that show the care is a covered, preventive service. If you can, ask your physician to write a letter explaining why the service is preventive and necessary.

Your insurance company has 30 to 60 days to respond, depending on your state and health plan. If your appeal is denied, try again. Some people win on the second go-round.

If your appeal is denied a second time, you can request an . That process is led by a medical professional who is supposed to make an unbiased decision. In California, for instance, many health plans fall under the jurisdiction of the Department of Managed Health Care.

“In 2023, 72% of health plan members that came to us and filed an independent medical review ended up getting the service that they requested,” said Mary Watanabe, who leads the department.

Keep deadlines in mind. How much time you have to file should be on your explanation of benefits. Your insurer is required by law to accept the external reviewer’s decision.

For more help starting an appeal or asking for an external review, visit or your .

5. Ask human resources for help.

If you get coverage through your job and you’re hitting roadblocks, consider emailing your human resources department. HR folks have contacts with the insurance companies you don’t and may save you a few calls to the 800 number on the back of your insurance card. Legally, HR is under no obligation to help, and covering a health service may not be in your employer’s financial interest. But sending HR the documents you prepared for the insurance appeal may prompt them to push the insurance company to take another look.

“The whole point of employers offering benefits is to attract and retain a solid workforce, right?” Volk said.

Making a case to HR may be a ramp toward getting the treatment or service covered the next time your company revises its health plan offerings, said , a consultant who advises businesses on medical billing.

She said consumers can do a quick online search to see whether other large insurance companies in their area cover the health care service they need. That information can give you leverage, Buckholtz said.

Going to HR helped Deutscher. Eventually, her employer said it would cover the cost of hearing tests for baby Beckham for the current plan year. Deutscher’s employer has a self-funded plan, which gives companies the ability to customize benefits. It ultimately decided to add hearing tests as a standard benefit for all employees.

“It’s been like this constant cloud hanging over my head, so for that to suddenly be lifted, it didn’t feel real. I also have never gone to my HR for something like this before. I didn’t even know this was an option,” Deutscher said.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. . The crowdsourced project is a joint production of NPR and ��ýҕ�l Health News.

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Listen: Cheap Health Insurance Isn’t Always Cheap

Jackie Fortiér — Tue, 21 Apr 2026 09:00:00 +0000

After some federal financial aid expired, many Americans found that high-deductible health plans were the only option they could afford.

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How To Make a High-Deductible Health Plan Work for You

Jackie Fortiér — Mon, 13 Apr 2026 09:00:00 +0000

(Oona Zenda/��ýҕ�l Health News)

An elementary school teacher chose a low-price health insurance plan but soon realized she wasn’t clear about what it would mean for her family’s finances.

— Madison Burgess, 31, of San Diego

The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006.

The longer she scrolled through the plan options, the more overwhelming it felt. Insurance jargon made it hard to tell what her family would owe if her husband got sick.

“I didn’t know what a deductible was, so I just went with what was cheap, and now I have regret,” she said.

Deductible:

The amount you as the patient have to pay before insurance picks up part of the tab

Premium:

The monthly bill for your policy, paid to the insurance company

Burgess had chosen a bronze plan and didn’t know HSAs were an option.

“I’ve never thought about having to put money away for a deductible,” she said.

Burgess and others are often more worried about socking away money for unexpected car and house repairs or vet bills.

If, like Burgess, you chose cheaper health coverage for this year only to discover you’re on the hook for meeting a high deductible, these tips can help you prepare.

1. You might qualify for an HSA and not know it.

These accounts build a cushion for future health costs, such as doctor visits, prescriptions, and even products like over-the-counter medicine, tampons, and sunscreen.

2. HSA-curious? Here’s how to open one.

You open a health savings account through a bank or other financial institution. The institution will issue you a debit card so you can make purchases from the HSA.

If you get insurance through your job, your employer may require you to use a specific IRS-approved company.

Many people decide they can’t afford to contribute to an HSA. For some households, the desire to set aside money for medical expenses competes with the need to pay rent and buy groceries.

But there’s a detail that can make it feel more manageable. Contributions don’t have to be large. Just a few dollars a month can get you started.

3. Preventive services should be covered at no cost to you.

All plans sold on marketplaces must cover at no cost to the patient as long as the care is provided in-network. Those services include routine immunizations and cancer screenings.

Check out your for more details.

4. Seek care early in the year.

5. Consider paying cash instead of spending down your deductible.

Paying cash may save you money, but the amount you pay generally won’t count toward your deductible or out-of-pocket maximum.

“If you don’t think you’re ever going to hit your deductible — you’re that young invincible, and your deductible is $10,000 — negotiate the cash price,” Donovan said.

6. On an ACA plan? Update your income and use an HSA to avoid a tax surprise.

She advises updating your marketplace profile as soon as your income changes, which could newly qualify you for Medicaid or a plan that contributes more toward your medical bills.

Taylor Cook contributed to this report.

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Vaccines Jettisoned by CDC Safeguarded Millions From Disease

Jackie Fortiér — Fri, 09 Jan 2026 19:30:00 +0000

The federal government scaled back its recommended childhood vaccines, sidelining six that have safeguarded millions from serious diseases, long-term disability, and death.

Federal and private insurance .

Experts on childhood disease were baffled by the change, which the Department of Health and Human Services said followed “a scientific review of the underlying science.”

Public health officials say the guidance puts the onus on parents to research each vaccine and its importance. Here’s what they prevent:

Meningococcal disease. About 600 to 1,000 U.S. cases of meningococcal disease are reported yearly, killing more than 10% of those it sickens and leaving 1 in 5 survivors with a disability.

Flu. The virus has killed hundreds of children in recent years, though it tends to be much more severe in older adults.

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The CDC Just Sidelined These Childhood Vaccines. Here’s What They Prevent.

Jackie Fortiér — Tue, 06 Jan 2026 23:00:00 +0000